MEDICARE: CAROLINA VELASCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1427848993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA VELASCO

Provider Business Mailing Address
First Line	:	1075 CREEKSIDE RIDGE DR STE 280
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-3504
Country	:	US
Telephone Number	:	831-254-9155
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 NYSTROM CT
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-2087
Country	:	US
Telephone Number	:	831-254-9155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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Directions to “ CAROLINA VELASCO ” Practice Location

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